Multicentric Reticulohistiocytosis

Multicentric reticulohistiocytosis is a rare systemic disorder characterized by cutanenus and mucous nodules and chronic polyarthritis seen most commonly in patients 40 to 50 years of age.

Radiographs reveal marginal erosions principally at the distal interphalangeal joints of the hands that spread centrally. Nodules and cysts are commonly seen at the insertions of the extensor tendons of the fingers.

Differential considerations include:

• Psoriatic arthritis: Asymmetric distribution, periosteal new bone formation, intraarticular ankylosis, and early involvement of the sacroiliac joints are seen in psoriatic arthritis, but are not typical of multicentric reticulohistiocytosis.
• Rheumatoid arthritis: Periarticular osteoporosis, thinning of the articular cartilage, and sparing of the distal interphalangeal joints are seen in rheumatoid arthritis, but not typical of multicentric reticulohistiocytosis.
• Erosive osteoarthritis: Also affects the distal interphalangeal joints of the hands, but the erosions are typically in the central part of the articular surface (gull wing appearance).
• Gout: Also has skin nodules, but the they are asymmetrically distributed in the periarticular soft tissues, in contrast to the cysts and nodules commonly seen at the insertions of the extensor tendons of the fingers in multicentric reticulohistiocytosis. Erosions in gout occur at or near joints with the typical "over-hanging margins."

References

Scutellari PN, Orzincolo C, Trotta F. Case report 375: Multicentric reticulohistiocytosis. Skeletal Radiol. 1986;15(5):394-7.